Fingerprint background checks mandatory for preventing Medicaid fraud, says CMS

released a letter early this month to Medicaid directors, which stated that beginning August 1, some providers must begin fingerprinting employees at locations that are considered “high-risk” for Medicaid fraud. This fingerprinting provision was actually part of the regulations for the Affordable Care Act, and was passed in 2011 in an attempt for the Department of Health and Human Services to prevent healthcare fraud. CMS finally implemented this provision and started conducting fingerprint checks in August of 2014. After August 1, 2015, Medicaid providers will have 60 days to implement background checking requirements, and one year to ensure their employees are fingerprinted. If they fail to complete these two provisions, the provider will be terminated from Medicaid enrollment. (They will also lose enrollment privileges for felony crimes, as well as crimes related to Medicare, Medicaid and the Children’s Health Insurance Program over the previous 10 years.) In 2014, Medicaid spent $310 billion on medical services for 60 million people in the United States. CMS estimates that, during this time, $17.5 billion of those dollars were lost to Medicaid fraud, up from only $3 billion lost to fraud in 2013. Each state will be required to determine which of its Medicaid providers are considered high, moderate or limited risk, and so far only those high-risk providers would have to comply with fingerprint background checks. All home healthcare agencies and durable medical equipment agencies will be subject to the fingerprint checks, as those providers have previously been considered significantly high-risk for fraud. “Strengthening and improving upon programs that provide vital services like Medicaid to millions of Americans is a continuous process,” said Dr. Shantanu Agrawal, CMS Center for Program Integrity Director. “At CMS we take seriously our responsibilities to taxpayers and beneficiaries.” Those agencies that have already conducted background checks on employees will not be required to do new ones.]]>

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